I’m proud to be a rural doctor. My training is in not just Primary Care but also in Emergency Medicine, Obstetrics and Anaesthesia.

To be able to serve their communities best, rural doctors need broad brush skills across the board. Rather than the finely-honed precision instrument of the specialist (akin to a scalpel), rural generalists are comfortable adapting to various needs, whether in clinic, hospital or at the roadside (akin to a Swiss army knife).

It’s an exciting time; former rural doctor and fellow South Australian Paul Worley has recently been awarded the role of Australia’s first Rural Health Commissioner and is focussed on ensuring a pathway from medical school, internship, junior medical officer training, registrar training and speciality training to become a specialist rural doctor with sufficient skills to meet community needs. These might include the ‘obvious’ procedural skillset of emergency medicine, obstetrics and anaesthetics…but also non-procedural sub-specialism such as paediatrics, palliative care, mental health and so on.

Rural Anaesthesia Down Under

My focus in recent years has been on rural anaesthesia; we’ve suffered in recent years from fragmentation of GP-anaesthetists between the silos of regional health services, States and traditional RACGP vs ACRRM divides. A recent GP-anaesthetist conference in WA was the nidus for the formation of a ‘Rural Anaesthesia Down Under’ Facebook group, which has already captured over 200 of the estimated 450 rural GP-anaesthesia in Australia! We’re having conversations on safety and quality, on clinical procedures, on training and upskilling – all with the emphasis on rural doctors being the experts to contextualising the discipline of anaesthesia to our rural environment.

There’s even talk of establishing a National Audit of Rural Anaesthesia practice, in terms of determining demographics of GPAs, of caseload and of course of safety compared to our FANZCA colleagues!

Establishing such baseline data may help us when arguing for the ongoing viability of anaesthetic services in the bush, as it’s unrealistic to expect FANZCAs to service rural Australia – indeed replacing the ‘Swiss army knife’ of the rural generalist with the partialist FACEM, FRANZCOG or FANZCA costs a health service far more – as these clinicians are generally uncomfortable to switch from anaesthesia to obstetrics to emergency medicine to primary care.

The experts in rural medicine are rural doctors!

In a similar vein, I’m really excited to see that Queensland is now asking for Expressions of Interest for training of rural generalists in endoscopy to GESA standards (Gastroenterology Society of Australia). The EOI can be read here and is a wonderful initiative to drive accessible services to rural Australians under the rural generalist model.

More and more rural doctors are gaining skills to enable them to best service their communities and relieve the pressure on tertiary centres in the city. It makes no sense to send uncomplicated cases, whether deliveries, endoscopy/colonoscopy or general surgery cases to the city when there are rural clinicians able to deliver the service…and rural hospitals with operating theatre capability which is under-utilised! Heck, I’d love to see city patients who are stuck on long waiting lists for elective surgery being offered the chance to have their surgery done in a rural area – can you imagine if the Government supported city folk to travel to Kangaroo Island to have their procedures done!

Of course, it’s not just doctors – remote area nurses (RANs) and nurse practitioner models are increasingly being used to broaden the skill set and scope of practice of nursing colleagues in the country. We need to move away from craft group and tribalism, and focus on the skillset required to ‘get the job done’

Are you a Rural Generalist who wants to learn endoscopy?

“Expressions of interest from Rural Generalists are now invited, with two training positions available in 2018. The training program will take place over 48 weeks, including two placements in a high volume setting, with the remainder of the training taking place in the rural setting. Applicants are requested to complete the attached self-assessment tool and return it to us at HIU@health.qld.gov.au by COB Friday 19 January 2018.”

Tim Leeuwenburg

RESUSCITATE - DIFFERENTIATE - INVESTIGATE

I am a Rural Doctor on Kangaroo Island, South Australia with interests in emergency medicine, anaesthetics & trauma. When not working I enjoy fiddling with chainsaws and seakayaking. Along with partner Patricia we rehabilitate orphaned wildlife and devise roadkill recipes.